The study by Rady et al of mortality in relation to random levels and maximal increments of total cortisol, organ failure, and sex in critically ill patients illustrates the necessity of better identifying subgroups of critically ill patients who will benefit from corticosteroid supplementation. Because of the study’s observational nature, it is difficult to extrapolate further conclusions.

They found no difference in overall mortality between patients who did and did not receive corticosteroids. This is in contrast to the landmark study by Annane et al1 that reported a significant improvement in mortality in randomized nonresponder patients. That study included only patients with severe sepsis, while Rady et al additionally included patients with circulatory failure secondary to systemic inflammatory response syndrome.